2012-478 Worlco Insurance Agency TOWN OF QUEENSBURY
742 Bay Road,Qticensbin-v,NY 12804-5902 (518)761-8201
Coininunity Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20120478 Application Number: A20120478
Tax aNfap No: 523400-296-011-0001-032-000-0000
Pcrinission is hereby granted to: WORLCO MAN AGEMENTSE'RVICES INC
[,'or property located ac 527 BAY Rd
in the Town of Q)Lleeosbviry, to construct or place
at the above location In accordance with application together with plot plans and other information hereto fAed
and approved and in corripliance With the N '.'S Uniform Building Codes and the Qucensburlv Zoning
0rdinance. TyL)e of Construction Value
Owner Address: WORLCO MANAGI-I'MI-INTSERVIC Sign
527 BAY Rd Total Valtle
QUEENSBURY, NY 12804
Contractor or BUilder's Name / \ddress Electrical Inspection Agency
Phin";&Specifications
2012-478 WORLCO INSURANCE AGENCY
10' x 4' =40 sq. ft complete construction of new freestanding ng sign and placing sign closer tet Bay Read than
Z17 C,
previous fs sign. (removing all parts of old freestanding sign inCkiding sign poles).
$120.00 PERMIT FEE PAID -THIS PERMIT EXPIRES:
(If a longer period is r"joiTed,an application for.an extension nitist be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of Queetisbury; Friday, November 02, 2012
SIGNIM BY for ihcTowii of Queensbury.
Director of Building& Codc Friforccirient
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• : OFFICE USE ONLY •N l --2,1 it ' 1,
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hb i ; s- r{ $ # '�
APPROVALS: DEPOSIT 1, i ,
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SIGN PERMIT APPLICATION: • iC,(1
A permit must be obtained before installation of your permanent sign. All applicants'spaces on this application must
be completed and must appear on thea plication form. ("AAR-- //� /► `L
OWNER:' '\C� Mcf.-a-4 yvu.1 tS�'-��CC'S IA/LC-INSTALLER/BUILDER: J t6 J g4 r- km.C 15P
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ADDRESS:6-�� , ADDRESS: t�I /►t'CC N /�g+ 6 o) 4% M'i Zi I,
PHONE NOS(S00-to l c --(D��c /Z2''PHONE NOS. C510 %I -C7 3/ (ci 7 j i+"ZG Z
LOCATION OF PROPOSED INSTALLATION:(LEGAL ADDRESS)5 a-7 Z4V ee�tScO,��� NY ( ZFoc.(
BUSINESS COMPLEX1 /PLAZA/MALL NAME:
BUSINESS NAME:V fACS— 1nC--F- ,�-t.rG,,A.Cn(. A- C�U1,L �^ r�
CONTACT PERSON FOR SIGN CODE COMPLIANCE:Mt_B t/I#/U St 5-16 THONE: 7./e.) 36'1-5 35
TYPE OF SIGN PROPOSED: /freestanding wall awning _projecting
IF SIGN IS TO BE ILLUMINATED,PLEASE INDICATE: _Internal `�Extemal _Incandescent _Neon _Other
DO SIGNS CURRENTLY EXIST ON THE PROPERTY? Lyes _No
IF YES,LIST ALL EXISTING SIGNAGE: 3/A )3/ 5/F c( 0(5A.N 5'n
e. `1e DJ
The application creates a change ;,./New
in the following existing site Change in number of signs from to
conditions(fill in all applicable +,/Change in setback for sign from -3,5 to /
spaces): I/Change in size of sign from 1'72 /t-7•0•• to t/ ) 54 irr
_Change in height of sign from / to &/
Change of wording/copy
from: to:
Sign Wording/Copy: 41)0,--/..-a) /N.5 ugA�C tl A 6-is N c /
r ,/
Sign size: Length /1' x Width =Total Sq.ft. ilo S Q�/[rSign Height(freestanding sign): i o ff'c)t:5/d'N
Color and Material to be used: 4/6 4-/-N4 W 7 M ''J/V�Li}l 116 L ilt/J S( F AY V l
✓ Provide 2 copies of a scaled drawing or surveyed plot plan with the following information:
o Location of sign(walls signs: drawing of the facade
the sign will be located on,indicate sign on facade)
o Height of freestanding sign QUESTIONS? CALL 7614256 OR EMAIL
o Depth of projecting sign codes(a)queensburv.net
o Distances from front and side property lines. VISIT OUR WEBSITE FOR MORE INFORMATION
✓ Provide 2 drawings or photos of sign design. www.queensburv.net
✓ Provide Applicant and Owner's signature(permission
for placement of sign on the property or building).
Declaration: To the best of my knowledge,the statements contained in the application,together with the plans and
specifications submitted,are a true and complete statement of all proposed work to be done on the described premises and that
all provisions of the Zoning Ordina -,and all other laws pertaining to the proposed work shall be complied with,whether
specified or noted,and that such !•rk is a b •a.wner.
APPLICANT SIGNATURE: / --e- DATE: 9 - s / Z
I hereby authorize the .'pl.,: o/to place . .'• :••'%
42- 1.(„s urRi2A.
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MAILING: 1110 Wl►7:
P.O. Box 332 • Glens Falls, NY 12801
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